Multiculturalism in Healthcare Aim at

Multiculturalism in Healthcare Aim at Long-Term Care The process of aging is inescapable, as every human being is its victim. Aging does not discriminate; transcending gender, economic class, ethnicity, religion and culture. During this process, individuals are subject to the diseases and disabling consequences associated with growing older. The medical and additional attention needed for the elderly population has the potential to require long-term care.

This need for extra assistance or medical care can cause strain on the elders' family, leading some families to seek services provided by long-term care hospitals, assisted living, hospice, and nursing homes. In the United States alone, there are an estimated 12 million people who need assistance with daily living, including such tasks as bathing, dressing, and eating (Chang, 2004). Millions of individuals in the U.S. choose to place loved ones and family members into long-term care, which inevitably introduces a range of different backgrounds to these long-term institutions.

Although long-term care is available in most cities throughout the U.S., not every family chooses to enroll their elderly family members (or those needing assistance) in these services. The trend is notably marked by culture, as various cultures have opposing views regarding family members being placed in nursing homes, and other long-term facilities. There are some cultures that demonstrate long-term care as commonplace.

Nursing home residents are currently older, sicker, and more likely to be mentally impaired than they were 25 years ago, and providing care for them can be regarded as a burden in some cultures, which should not be shouldered by the family (Weiner, & Ronch, 2003). Other cultures view caring for elderly family members as a tradition and is incorporated into familial roles (Dodson, & Robayo, 2003). These cultures tend to consider nursing homes and long-term care facilities as a violation of their cultural traditions.

Despite the opposing cultural views, multiculturalism is still represented in nursing homes and long-term care institutions in the U.S. Every patient and resident admitted into long-term facilities brings their personal experiences and values. This presents a host of sub-cultures into long-term care facilities, including: race, ethnicity, language, gender role, gender identification, food, and religion. Every resident brings their social and cultural identities to their respective facilities, creating various degrees of diversity in long-term care.

This draws the attention of researchers and scholars, which has lead to observations surrounding sub-cultural views and practices. Scholars advise such facilities as nursing homes often neglect social and cultural supports needed by the elderly (Banaszak-Holl, & Copen, 2002). Cultural values regarding long-term care as an acceptable means to provide for the elderly can be exemplified by the presence of racial and ethical cultures in nursing homes. The White American culture comprises the majority of nursing home population, while Hispanic and Asian cultures are significantly a minority.

The presence of these populations speaks to the views of their respective cultures. Quality of care provided by long-term facilities is often questioned, and the representation of minorities also leads researchers to inquire to the particular care given to lesser represented cultures, such as African-Americans, and Hispanics. The beliefs and understandings of cultures are implicated in a myriad of ways, with the multiculturalism of nursing homes and long-term care being a prominent representation of opposing views.

According to the National Nursing Home Survey, there is a total of 1.4 million nursing home residences, almost 1.3 are white, less than 200 thousand are African-American, 57 thousand Hispanic or Latino, and 30 thousand accounts for other races that were not specified (Center for Disease, 2010). The data presented by the survey explains 91% of all nursing home residents are White American (Center for Disease, 2010). This figure assists the validation of culture values belonging to White Americans in regards to placing elderly family members into nursing home care.

The statistic suggests White Americans view nursing homes and long-term care as a means to support the elderly and provide their needed assistance and attention, and is not regarded with such negative connotations as other cultures. In contrast, elderly African-Americans are admitted to nursing homes at a far lower rate than whites (Belgrave, Wykle, & Choi, 1993). The African-American population represents less than 2% of all residents. There are researchers who advise the lower number of African-Americans in nursing homes is not a matter of culture, but a matter of finances (Randall, 2004).

It is possible that more African-Americans can not afford the great monetary expense that is coupled with nursing home care, versus an indication of preference toward home health care. One study examined the racial separation in long-term care, focusing on the distribution of African-Americans in nursing homes. The group sampled a total of 181 residential care/assisted living facilities and 39 nursing homes in 4 states. The study found African-American residents to be concentrated in a few predominantly African-American facilities, and Whites residing in predominantly White facilities.

The African-American facilities were primarily in rural, nonpoor African-American communities. The majority of these long-term facilities admitted individuals with mental retardation and problems with ambulating, and showed evidence of lower cleanliness, maintenance, and lighting ratings (Howard, Sloane, Zimmerman, & Eckert, 2002). The implications of the findings are profound, however the study concludes by considering the racial discrepancies as a result of economic factors, exclusionary practices, or the choice of the resident.

This study is not adequate enough to define segregation as a means for care inequality, and any direct correlation remains undetermined (Howard, Sloane, Zimmerman, & Eckert, 2002). The Hispanic and Latino population comprise the third largest tier in nursing homes; only meeting less than 0.5% of all residents. This percentage of Hispanic representation reflects a cultural understanding, as Hispanics exhibit a distinct preference for home health care over nursing homes (DiMaria, 2006).

Hispanics exude a cultural partiality to caring for elderly family members at home, and requesting home health-assistance for additional help if necessary. Although this cultural preference is understood, there is still argument to be made regarding the financial accessibility to healthcare for Hispanics and Latinos. In the U.S. more Latinos are uninsured, and this is a significant hurdle to obtaining healthcare. The monetary demand from nursing homes also limits resources and options (DiMaria, 2006). A study was conducted to examine the distribution of elderly Hispanics residing in nursing homes.

The study showed elderly Hispanics are more likely than Whites to live in nursing home facilities that are understaffed, have deficiencies in performance, and provide poorer care (Fennell, Feng, Clark, & Mor, 2010). Similar to the study investigating the dispersion of African-American residents, the study is unable to conclude defining parallels between segregation and care inequality. The fourth and fifth largest ethnic group comprising nursing home residents are Asian/Pacific Islanders and American Indians, respectively.

The Asian population accounts for less than 15 thousand residents, while American Indians are represented by less than 6 thousand residents total in the U.S. (Larson, 2000). Multiculturalism is evident within nursing homes, with a high unbalance between the majority and minorities. As previously discussed, significant concern drawing the focus of researchers is the quality of life provided to racial and ethnic minorities receiving long-term treatment. One disparity is the lower level of care and attention given due to language concerns.

The language barrier impacts a residents' ability to comprehend, read, and communicate (DiMaria, 2006). This cultural and language hurdle prevents common understanding and communication, consequently affecting medical care and attention needed for these minority residents. Researchers advise, however, quality of life is difficult to measure. Studies to measure quality of life are of low priority to nursing home staff, due to the time and commitment required to influence practical change within all nursing homes (Kane, 2003).

To improve quality of life for residents, regardless of culture, the voices of the residents must be heard and considered. One study showed in a theoretical analysis, that residents perceived quality of life as a reflection of their health and social supports. Nursing homes must nurture positive environments to satisfy the residents' need for social engagement (Kane, 2003). To implement this practice across the cultures, language and communication barriers must be lowered. Transcending the confines of any race, culture, or language, is the basic distinction of gender.

Even though the categories of male and female are easily defined, the gender roles and gender identities associated with them are not. According to the same National Nursing Home Survey, there are just over 1.4 million residents currently in nursing home care in the U.S. The female to male ratio is almost three to one, with over one million females, and 400 thousand males. The majority of all residents, over 1.1 million, are age 75 and over (Center for Disease, 2010).

Gender trends have been observed by professionals within the context of long-term care, indicating the prevalence of one sex over the other. For example, in hospital settings, women tend to be hospitalized less frequently than men, while more women use nursing homes and hospice care more frequently (Bird, Lemon, & Intrator, 2000). Researchers question the effect of gender differences as it relates to health within the long-term care setting. One study examined the gender roles associated with social supports in nursing home residents.

The aim of the study was to link the connection between gender identity and willingness to engage with social supports. The study surveyed 65,838 nursing home residents in Michigan for marital status (including if one was widowed, divorced, or never married), contact with friends and family members, and the engagement or withdrawal from social activity. The study showed more men than women are married (42% compared to 15%), while more women than men are widowed (69% compared to 30%).

The results generated preliminary evidence that women tend to retain more contact with friends and family, and also participate at higher levels of involvement than men (Banaszak-Holl, & Copen, 2002). The study marked a significant gender difference regarding social supports, as the large majority of men are married compared to women. Social supports in nursing home settings are critical to nurturing health and well-being, and women are at a disadvantage due to the lack of availability for social opportunities in long-term facilities.

Nursing homes must recognize and establish social opportunities for residents to further embellish gender roles and identities. One aspect within long-term care that lacks indication of multiculturalism is the food culture. The topic of food and nutrition in nursing home services is frequently questioned, and raises legitimate concerns for those studying quality of life in long-term institutions. It is estimated that 16% of Americans age 65 and older are not regularly receiving adequate nutrition, and one in four elderly adults is at risk of malnutrition (Nutrition and aging, 2000).

A contributing factor to inadequate nutrition in residents is the at-capacity and under-staffed nature of most nursing homes. In one shift, nursing home employees can be responsible for preparing 7 to 10 residents for meals, and does not provide much time to feed those who cannot feed themselves (Nutrition and aging, 2000). Researchers also observe the lack of food culture as a source of poor nutrition, advising the lack of appealing meals and snacks contributes to the resident's lack of motivation to eat.

Providing bland, simple, undiversified meals does not improve quality of life or increase social support for residents (Castellanos, 2007). Also, this lack of food diversity does not speak to the minority populations in nursing homes. Plain, Americanized meals does not respect the cultures, and wants, of those living in long-term care. When admitted to long-term care, residents also bring their ethical values and religions into the institution. Some nursing homes predominately represent one general religion among residents, while other facilities have several different religions represented.

In long-term care, religion can be a means for individuals to cope during the later years of their life, and can be a psychological tool to promote well-being. One organization reports 88% of residents aged 70 and up consider themselves Christian, and 68% of them pray daily (Senior Living, 2010). Nursing homes must nurture the religious need in these residents, while also supporting the religious minorities and respecting non-believers. This could also be a means for these facilities to provide additional social support for residents.

One study inquired into the residents' rank of importance of their religion. The research examined two nursing home facilities in Boston, and questioned 145 cognitively intact to moderately impaired long-stay nursing home residents. The results showed 54% of residents rank religion as very important, 27% regards religion as somewhat important, and 19% of residents rank religion as not important (Scandrett, & Mitchell, 2009). Overall, religion holds some significance to the majority of all nursing home residents, and nursing homes should cultivate religious practice for those seeking it.

Religion is a considerable sub-culture which should be recognized as it possesses the potential to improve mental and emotional quality of life. Looking to the future, nursing homes and long-term care facilities must prepare for a serge in resident population and the dimensions of culture. In the U.S., it is projected that by the year 2050, 78.8 million people will be elderly, and the population of the elderly will be the most racially diverse in American history (Randall, 2004).

The now marginal minority group will swell to 34% of the total elder population, to include African-Americans, Hispanic and Latino, and Asian cultures. The African-American elderly population alone is projected to increase almost 300% (Randall, 2004). In recent years, the number of elderly Hispanics in nursing home care has also increased, from 5% in 2000 to 6.4% in 2005 (Fennell, Feng, Clark, & Mor, 2010). In addition to racial and ethical diversity, roles of gender identity are also expected to rise.

The recent development of transgender-inclusive nondiscrimination laws gives encouragement to transgender elders to receive more unbiased care -- increasing the rate of transgender admittance in nursing homes (Redman, 2011). To prepare for the increased number of residents and intensified multiculturalism, nursing homes and long-term care institutions must change their own culture and practices. Nursing homes must assess their quality of life, adequacy of staff, and prepare for high occupancy rates (Doty, Koren, & Sturla, 2008).

Researchers indicate that additional federal support must be given to age-related research, including diseases, and ways to increase and improve longevity. One step in this direction included a 13.4% increase in funding to the National Institutes of Health under the Bush administration (Nyberg, 2001). The aging Baby Boomer generation is expected to strain long-term facilities and healthcare needs, and it is imperative the U.S. prepare for its largest recorded.